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SAN FRANCISCO – Despite calls from some of its member doctors, the American Medical Association on Tuesday declined to endorse smallpox vaccinations for all Americans.

Instead of vaccinating the entire nation, the 538 delegates attending the AMA’s annual winter meeting voted overwhelmingly to continue planning and studying the repercussions of such a mass inoculation.

“We do not yet know that the bad guys have the smallpox virus,” said Dr. Ron Davis, a public health expert from Detroit and a member of the AMA’s 20-member board of trustees. “There are huge, complex issues involved and due deliberation is needed.”

Among the biggest concerns is that the vaccine itself could kill as many as 300 people and sicken thousands more if the entire U.S. population of 280 million people was vaccinated — a risk that Salt Lake City obstetrician and AMA board member John C. Nelson said is unwarranted.

“There is not a single reported case of smallpox anywhere in the world right now,” Nelson said.

There’s even disagreement whether those already inoculated — nearly every American 32 or older — will need another vaccination to prevent a smallpox infection.

“Immunity does last years,” Davis said. “But it does weaken over time.”

Also, babies younger than 1 and people with weakened immune systems such as those with HIV — diagnosed and undiagnosed — couldn’t withstand smallpox vaccinations, doctors said.

The action Tuesday was in response to a proposal by Florida doctors that the AMA back nationwide vaccines despite those risks.

“We are at threat,” Dr. Bernd Wollschlaeger of North Miami Beach, Fla., said during debate of the issue on Sunday.

Others urged the AMA to endorse voluntary vaccinations that would be left to the discretion of prescribing doctors.

But Davis pointed out Tuesday that the United States has only 15.4 million doses of vaccine currently available. The federal government did recently agree to pay a total of $428 million to Baxter International Inc. and Acambis Plc. for 155 million doses of smallpox vaccine. But those new doses won’t be available for at least a year.

Until then, Dr. Joy Maxey of Atlanta advocated inoculating doctors such as herself to protect against contracting the disease from patients.

“We should at least be offered that opportunity,” Maxey said Tuesday. The AMA sent Maxey’s proposal to vaccine so-called “front-line defenders” such as doctors and paramedics to a committee for study.

Smallpox vaccination stopped in the United States in 1972, and the disease was eradicated worldwide by 1980. Two smallpox virus samples remain — one in the United States and the other in Russia. Concerns about security at the Russian lab have existed and been exacerbated by the proliferation of anthrax cases.

A smallpox epidemic would be much worse than an anthrax outbreak because it is contagious and deadly. Roughly 30 percent of those who contract smallpox die.

“I think the doctors are as scared as anyone else,” Nelson said.

Still, Nelson said detailed scientific studies and more discussion among doctors and federal health officials need to occur before determining what should be done.

The Centers for Disease Control and Prevention will discuss the smallpox issue on Dec. 12-13. Last week, the CDC issued a 300-page report called the “Interim Smallpox Response Plan and Guidelines,” which recommends waiting until an outbreak occurs before beginning vaccination.

Even then, the CDC report said a technique called “ring vaccination,” where only healthy people around a smallpox victim receive the vaccine, has proven to be effective.